Presentation 1 - Preparation for Safe Practice as an Intern

Team Health Right Start Program Showcase27 February 2012

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Right Start Forum

Preparing for Safe Practice as an Intern

(PSPI Program)

Presenter:

Dr James Edwards

Project Partners:

Sydney Medical School

Northern Sydney Local Health District

Sydney Local Health District


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Faculty

Merrilyn Walton: Professor of Medical Education (Patient Safety) School of Public Health, Sydney Medical School

Stewart Dunn: Professor of Psychological Medicine, Northern Clinical School

James Edwards: Emergency Physician, Royal Prince Alfred Hospital

Kar-Soon Lim: Senior Lecturer Anaesthesia, Concord Clinical School

Vasi Naganathan: Ass. Professor Medicine, Concord Clinical School, Centre for Education and Research on Ageing (CRGH)

Leonnie Watterson: Clinical Associate Professor, Anaesthesia, Northern Clinical School, Director

Jennifer-Smith Merry: Research Fellow, School of Public Health

Susan McKenzie, Clinical Lecturer, Sydney Medical School

Clare Richmond: Emergency Physician, Simulation Fellow, RNSH, RPAH

Gillian Nisbet, PhD candidate & project manager

Barbara Cassidy, Educational design instructor

Beth Vogelzang (Acting) Nursing Unit Manager, Concord Repatriation General Hospital

Evelyn Dalton Manager Clinical Simulation Laboratory/Academic Sydney Nursing School

Registrars and resident medical officers, actors, volunteer nurses.


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Introduction & Background

July phenomenon Increased errors occur with new house staff at the

beginning of the academic year Inaba K, et al., Complications and death at the start of the new

academic year: Is there a July phenomenon. The Journal of Trauma: Injury Infection and Critical care, 2010. 68(1): p. 19-22.

Haller G, et al., Rate of undesirable events at the beginning of academic year :retrospective cohort study. BMJ, 2009: p. 339:b3974.

January phenomenon Hilmer S, et al., Do medical courses adequately prepare interns for safe

and effective prescribing in New South Wales public hospitals? Internal Medicine Journal, 2009. 39: p. 428-34.


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Aim & Methods

Program Aim: Reduce adverse events or the potential for adverse

events for patients being treated by interns during their first months of employment.

Learning Outcomes: Demonstrate knowledge of and be confident in

situations that have the potential to harm a patient Identify the ‘red flag’ situations Know when to seek assistance Act appropriately to avoid an adverse event.


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Aim & Methods

Program designed around 6 theme areas: Clinical challenges – case management problems Procedures – skills for discrete procedures Organisational skills – clinical clerking – working safely and

effectively within the system The deteriorating patient – clinical emergencies Interactive – patient doctor, colleague communication Self-management – behaviours directed as self-regulation

and professionalism

5 Day experiential program for pre-intern medical students:

Case-based learning; simulations; workshops; role plays


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Results

Process evaluation 37 Pre-internship medical students 70% of participants rated Program 8 out of 10 or above Clinically focused sessions well received:

Active participation - time for practice and questions Based on real cases/ real mistakes – met immediate needs of

participants Participants ‘put in situation’ – i.e. it could have been them

that had made the mistake

All but 4 participants indicated that all final year medical students would benefit from such a course

Impact evaluation - ongoing

Outline your project’s results drawing on process (logistics, implementation), as well as qualitative and quantitative data analysis findings


7Conclusions & Lessons LearnedPSPI program fills the gap in transition from student

to practitioner

Maintain clinical focus on avoiding adverse events: Retain the most effective and efficient learning methods Integrate communication skills development into clinical

case scenarios rather than a separate session Provide opportunities for individual feedback on

performance

Clinician teachers are prepared and include Clinician educators with recent graduate experience Experienced clinicians with teaching and supervisory

responsibilities


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Where to from here?

Finalise the PSPI Curriculum Guide incorporating: Principles and background for content covered and

teaching strategies adopted (i.e. how to teach) Comprehensive description of topics, resources and

facilitator actions

Develop the PSPI Facilitator Training Program (How to teach)

Make available the PSPI program to all medical schools

Continue research plan to evaluate the longer term impact of PSPI Program

Opportunities for IPL??

Health & Medicine

Presentation 1 - Preparation for Safe Practice as an Intern